Letter on Obstacle for Personal Budgets

This letter has been sent to the Ministers responsible for personalisation of social care for children and adults in England, to the CEO of the NHS and to the leaders of the two associations for Directors of Social Services (children and adults). It describes a serious policy problem that exists because current systems of commissioning are operating in accordance with out-of-date policies. The principles of personalisation have not been applied to procurement and commissioning systems. Without proper attention it is likely that progress on personalisation will be seriously impeded.

Text of letter sent 15th March 2017

I am writing to you because progress on one of the key elements of the cross-government personalisation strategy (for children and adults and in health, education and social care) has now stalled.

One of the most important reasons for this problem seems to be a policy confusion about best practice in procurement. This problem could be resolved by a clear statement of policy and a change in the current monitoring systems for personalisation.

Best practice in support and the policy of personalisation both depend on ensuring that decisions about care and support are individualised and that they are made by the person, the family or someone close to them who has a good understanding of their needs and aspirations.

In 1996 the Direct Payments Act made it possible for people to take control of the budget for their support. Over the past 21 years this policy has been extended to enable growing numbers to use direct payments. Usually people are then required to use this money to employ their own support team.

However, not everybody wants to manage a direct payment nor to employ their own staff and take on the relatively onerous responsibilities of being an employer. It seems likely that we are close to the upper limit in the use of direct payments in this way. If the goal is to ensure that everyone can receive personalised support then another approach to personalisation is necessary.

Fortunately it is possible for people to get personalised support without forcing people to become employers:

People can use their direct payment to purchase support from an organisation that will employ and manage any support staff. The additional management costs necessary can be built into the direct payment.

Commissioners can enable people to choose who will provide them with support and then fund this support by contracting directly with the support provider in a way that gives the support provider flexibility to personalise the support and gives the person the right to terminate that contract.

These two approaches enable commissioners the opportunity to set up a system of managed personal budgets which give people choice, control and the ability to design more effective support solutions. This kind of support solution has persistently been associated with higher rates of satisfaction, safety, effectiveness and efficiency. These systems enable personalised support without burdening people with unnecessary additional responsibilities.

However, despite the fact that personalised support has been in operation for at least 21 years, it has not benefited from the same level of attention as direct payments. Currently it is only available in a few areas of England and for very small numbers.

In principle the idea that people can have personalised support without having to manage a direct payment and without having to become an employer has been either an explicit or implicit feature of official policy. Recent guidance from TLAP and from the NHS continues to reinforce the importance of this model. However, in practice, progress towards Personalised Support has been blocked by a series of significant obstacles:

Many commissioners do not make it clear that people can choose to spend their direct payment on a service provider, nor do they calculate the size of the personal budget in a way that makes this choice feasible.

Many commissioners believe that EU Procurement rules dictate that they must put contracts for support out to tender and that they therefore cannot give people control over the decision about who provides them with support.

Currently national monitoring systems do not count progress in providing managed personal budgets, although they do count nominal budgets, despite that fact these do not create any meaningful flexibilities or opportunities for personalisation.

Unless there is much greater clarity about these matters it is unlikely that there will be any significant further progress in personalisation. For this reason we are requesting that policy-leaders address these issues directly. We would recommend:

Make clear that the existing obligation to offer eligible people and families a direct payment includes a responsibility to define that offer appropriately. That means people should be told clearly that they do not need to become an employer in order to receive a direct payment and that they can pay a third party to provide support or manage their budget.

Make clear that people are also free to choose a suitable service provider with whom the commissioner can contract on their behalf. This kind of citizen-led procurement should be treated as best practice in procurement, rather than as it is currently, somehow questionable.

All monitoring systems should be modernised to include a clear measurement for managed third party personal budgets, distinct from self-managed direct payments or commissioner controlled budgets.

Greater recognition of the value of personalised support and greater encouragement to service providers to develop more personalised solutions.

Yours sincerely

Dr Simon Duffy, Director of the Centre for Welfare Reform

Sam Sly, Coordinator of Citizen Network England

W D Blewitt, Chairman of the Cornerstone Carers’ Reference Group

Steven Rose, CEO, Choice Support

John Dalrymple, CEO, In Control Scotland

Frances Brown, Director, Radical Visions

Tanya Moore, Senior Clinical lecturer in social work and social care, TheTavistock and Portman NHS Foundation Trust.

Catherine Hale, Researcher, Centre for Welfare Reform

Mike Llywelyn Cox, member of Equal Lives

Helen Collins, Day Care Lead, Meadow Well Connected

Dr Liz Ellis, Researcher, University of Gloucestershire

Melanie O'Neil, Mother to Mark Phillipson

Jenny Carter, Partners in Policy-Making Graduate, Lifelong Member of Learning Disability England and Co-lead for Self Advocacy in Wirral

Jo Hough, Co-Director Inclusion East CIC

Lynne McCarrick, Mother of Chris, who has autism

Lisa Watchorn, Self-advocate, Partners in Policy-Making Graduate and Mum of two young men with disabilities